COVID-19 and HbA1c
Dr Binayak Sinha discusses with Diabetes Health team how a rise in both HbA1c and Diabetes-related complications are seen with increasing duration of the pandemic.
A research article was published in the journal Diabetes & Metabolic Syndrome: Clinical Research & Reviews. The article was authored by Dr Samit Ghosal, Dr Binayak Sinha, Dr Milan Majumder and Dr Anoop Misra.
Could you explain why this study was conducted?
The COVID-19 pandemic caused by the SARS COV-2 (Novel Coronavirus) has pushed the world to the brink of destruction, debility and death. To prevent India from imploding due to this monstrous viral onslaught the Government of India had rightly instituted a mobility restriction of all services in the whole country. This study was conducted as a mathematical model to predict the impact of this mobility restriction on Diabetes control and to predict the effect of the control on complications of Diabetes.
What were the findings of the study?
First of all we need to realise that these are predictive and mathematical models. These models are mathematically robust, but do not take into consideration variables like behavioural change, government involvement in healthcare, tele-medicine etc. So this predicts the worst case scenario that there would be 2.5 per cent increase in HbA1c (worsening diabetic control) which would translate into worsened microvascular complications (eye disease, kidney disease and nerve disease) over one year.
How can these findings be applicable in a real world scenario?
Its applicability lies in making people and doctors aware of the risk Diabetes may pose. It also makes people aware of all take corrective steps to ensure that such worsening of control does not occur.
Did your study find any particular reason why HbA1c increased during a lockdown?
No. This is a mathematical model based on previous disasters like Gulf War, Tsunamis etc. It did not look for reasons. During a natural disaster scenario, one of the biggest problems is lack of access to medical facility and medicines due to supply chain logistics being affected.
Can lifestyle changes accompanied by increased stress levels be termed as one of the reasons for a possible increase in HbA1c levels?
Definitely, lack of exercise and healthy food could contribute. In addition, there has been a breakdown in the supply chain of medicines and insulin. That is slowly getting corrected. Stress levels have no direct correlation with HbA1c. But I think the sum of all these factors rather than any single individual factor would contribute.
Is there a direct correlation between increased HbA1c and risk of COVID-19?
Correlation between COVID and Diabetes is still being researched. Current evidence suggests that the risk of COVID may not be higher with worsened control, but the outcomes in COVID may be worse in Diabetes with poor control.
Should people with Diabetes increase self-monitoring of blood sugar levels during the pandemic?
Naturally. Awareness improves control in all lifestyle diseases.
Are there any best practices that you have identified during your research that doctors should convey to their patients?
Watch your diet and exercise regularly, even while you are at home. Take your medicines regularly. Monitor your blood sugar and blood pressure if possible. Consult your doctor if you need, tele-medicine is quite an acceptable choice in this scenario. Most importantly, stay safe at home and wash your hands regularly.
What advice would you give to people with Diabetes during the pandemic?
Be aware and take precautions. But do not panic. There is no reason to do so.
Dr Binayak Sinha is a renowned Endocrinologist practicing all aspects of general endocrinology but has a special interest in Obesity, Pregnancy and Diabetes, Polycystic Ovarian Syndrome and Reproductive problems. His area of research and specialist training has been in Reproductive Diabetes and Endocrine diseases.